Medicaid: Legislation Needed to Improve Collections From Private Insurers
HRD-91-25
Published: Nov 30, 1990. Publicly Released: Jan 08, 1991.
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Highlights
Pursuant to a congressional request, GAO reviewed problems that state Medicaid agencies experienced in collecting from third parties, focusing on out-of-state insurers and employee health benefit plans covered under the Employee Retirement Income Security Act of 1974 (ERISA).
Recommendations
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| Congress should amend federal law to explicitly state that Medicaid is payer of last resort, give states the authority needed to recover from all liable third parties, and provide effective mechanisms for enforcement. |
Closed – Implemented
|
The Omnibus Budget Reconciliation Act of 1993 requires states to enact laws prohibiting insurers (including group health plans under ERISA, service benefit plans, and HMOs) from taking Medicaid status into account in enrollment or payment for benefits, and to enact laws giving the state rights to payments by liable third parties, effective October 1, 1993. |
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Topics
Collection proceduresstate relationsHealth insurance cost controlInsurance regulationJurisdictional authorityMedical expense claimsPublic health legislationRefunds to governmentState-administered programsMedicaid